ABSTRACT
Ulcerative colitis is a chronic inflammatory disease characterized by a recurrent and remitting course. Clinical remission and mucosal healing are the current therapeutic goals in management. The histological remission could be a better objective because of its prognostic impact. OBJECTIVE: To evaluate endoscopic and histological activity as predictors of clinical relapse in patients with ulcerative colitis. MATERIALS AND METHODS: Prospective descriptive study conducted from January 2015 to June 2018 at Guillermo Almenara Irigoyen National Hospital. Thirty-three patients diagnosed with ulcerative colitis who presented clinical remission after a flare were evaluated. Endoscopic remission was assessed (Mayo Score ≤1) after 6 months of follow- up with ileocolonoscopy and rectosigmoid biopsies. Histological remission was defined as score < 2 in the Simplified Geboes Score (SGS). Follow-up was performed for one year to observe relapses. RESULTS: 26 (78.8%) patients achieved endoscopic remission at 6 months (mean age 53 years, males 57.7%). Histological remission was observed in 69.2% (18/26). After 1 year of follow-up, 83.3% (15/18) of the patients who presented clinical, endoscopic and histological remission remained clinically asymptomatic. The RR of clinical relapse at one year was 3,18 (95% IC, 1,58-6,42, p=0,004) in patients without endoscopic remission and 4 (95% IC, 1,34-11,94, p=0,003) in patients without histological remission. CONCLUSIONS: Histological activity could be a better predictor of relapse compared to endoscopic remission, and should be the final therapeutic objective in the management of patients with ulcerative colitis.
Subject(s)
Colitis, Ulcerative/pathology , Colon/pathology , Colonoscopy , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Recurrence , Young AdultABSTRACT
OBJECTIVE: To identify sociodemographic, clinical, and endoscopic characteristics in patients with inflammatory bowel disease (IBD). MATERIALS AND METHODS: The study period was from January 2004 to December 2014. The final diagnosis was determined by clinical gastroenterologists experienced in the diagnosis and management of IBD, based on internationally accepted diagnostic criteria. RESULTS: 105 patients with IBD were studied, 77% with ulcerative colitis (UC) and 23% with Crohn's disease (CD). The average age of initial diagnosis for UC and CD was 53.02 and 57.7 years, respectively. Regarding the gender distribution, the male:female ratio was 1.3:1 for UC and 2:1 for CD. Predominant clinical manifestations were: diarrhea (76.5%) in CU and lower gastrointestinal bleeding / abdominal pain (66.6% for each symptom) in EC. The predominant form of presentation was moderate for both CU (49.3%) and EC (62.5%). 47% of patients with UC had extensive colitis and 54.2% of patients with CD had Ileocolitis. 6.2% of the UC patients underwent surgery, whereas 50% of the CD patients required it. CONCLUSIONS: There is a tendency to an increased detection of cases of Crohn's disease in our country and in Latin America with respect to previous studies. There is a prevalence of moderate forms of presentation for both UC and CD, and high percentages of surgery in EC is evident.
Subject(s)
Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/epidemiology , Crohn Disease/diagnosis , Crohn Disease/epidemiology , Adolescent , Adult , Aged , Child , Colitis, Ulcerative/therapy , Crohn Disease/therapy , Female , Hospitals, Urban , Humans , Male , Middle Aged , Peru/epidemiology , Retrospective Studies , Risk Factors , Tertiary Care Centers , Young AdultABSTRACT
OBJECTIVE: Evaluate the diagnostic and therapeutic utility, safeness, efficacy and complications of double-balloon enteroscopy (DBE). MATERIAL AND METHODS: This prospective, descriptive study of DBE took place between July 2010 and June 2015 at the service of Gastroenterology of Hospital Nacional Guillermo Almenara Irigoyen- Lima Peru. 129 DBE were performed in 121 patients with the Fujinon EN-450T5 double balloon enteroscope, with conscious sedation and with previous bowel preparation. All of them signed an informed consent. RESULTS: The mean age was 56.6 years. Capsule endoscopy intestinal study was performed previously in 77 patients (63.6%). The most frequent indication for DBE was bleeding of middle intestine (61.2%). The approach used was more antegrade (69%). The maximum distance reached was 570 cm in antegrade method. The average duration for both routes is 117.45 minutes. Vascular ecstasies (56.1%) were the most frequent causes of obscure gastrointestinal bleeding. The diagnostic yield was 83.7%, higher than other series. The most widely used therapeutic procedure was argón plasma thermo coagulation. Like other studies, patients had good tolerance to the procedure and no major complications. CONCLUSIONS: In our patients studied the EDB has proven to be a secure, useful and efficient technique for the diagnosis and treatment of several diseases of the small intestine, especially in obscure gastrointestinal bleeding.
Subject(s)
Double-Balloon Enteroscopy , Intestinal Diseases/diagnostic imaging , Intestinal Diseases/therapy , Intestine, Small/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Double-Balloon Enteroscopy/adverse effects , Female , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Hospitals, Public , Humans , Intestinal Diseases/complications , Male , Middle Aged , Peru , Prospective Studies , Treatment Outcome , Young AdultABSTRACT
Evaluar la utilidad diagnóstica y terapéutica, la seguridad, eficacia y complicaciones de la enteroscopía con doble balón (EDB). Materiales y métodos: estudio descriptivo prospectivo realizado en el Servicio de Gastroenterología del Hospital Guillermo Almenara Irigoyen LIMA-PERÚ, durante el periodo entre julio 2010 a junio 2015. Se realizaron 129 enteroscopías en 121 pacientes bajo sedación consciente y con preparación previa. Se utilizó un enteroscopio de doble balón EN-450T5 Fujinon. Los pacientes firmaron un consentimiento informado previo al examen. Resultados: La edad promedio fue 56,6 años. Previamente se realizó estudio del intestino delgado con cápsula endoscópica en 77 pacientes (63,6%). La indicación más frecuente fue la hemorragia digestiva de origen oscuro (61,2%). La vía de abordaje más utilizada fue la anterógrada (69%). La distancia máxima alcanzada fue de 570 cm por la vía anterógrada. El tiempo promedio de duración por ambas vías fue de 117,45 minutos. Las ectasias vasculares (56,1%) fueron las causas más frecuentes de hemorragia digestiva de origen oscuro. El rendimiento diagnóstico fue 83,7%, superior a otras series. El procedimiento terapéutico más utilizado fue la termocoagulación con argón plasma. Al igual que otras series, los pacientes toleraron la EDB muy bien, sin mayores complicaciones. Conclusiones: En nuestro grupo estudiado la EDB ha demostrado ser una técnica segura, útil y eficaz para el diagnóstico y tratamiento de las diferentes enfermedades del intestino delgado, sobre todo en la hemorragia digestiva de origen oscuro...
Evaluate the diagnostic and therapeutic utility, safeness, efficacy and complications of double-balloon enteroscopy (DBE). Material and methods: This prospective, descriptive study of DBE took place between July 2010 and June 2015 at the service of Gastroenterology of Hospital Nacional Guillermo Almenara Irigoyen- Lima Peru. 129 DBE were performed in 121 patients with the Fujinon EN-450T5 double balloon enteroscope, with conscious sedation and with previous bowel preparation. All of them signed an informed consent. Results: The mean age was 56.6 years. Capsule endoscopy intestinal study was performed previously in 77 patients (63.6%). The most frequent indication for DBE was bleeding of middle intestine (61.2%). The approach used was more antegrade (69%). The maximum distance reached was 570 cm in antegrade method. The average duration for both routes is 117.45 minutes. Vascular ecstasies (56.1%) were the most frequent causes of obscure gastrointestinal bleeding. The diagnostic yield was 83.7%, higher than other series. The most widely used therapeutic procedure was argon plasma thermo coagulation. Like other studies, patients had good tolerance to the procedure and no major complications. Conclusions: In our patients studied the EDB has proven to be a secure, useful and efficient technique for the diagnosis and treatment of several diseases of the small intestine, especially in obscure gastrointestinal bleeding...
Subject(s)
Humans , Intestinal Diseases , Double-Balloon Enteroscopy , Gastrointestinal Hemorrhage , Intestine, Small/pathology , Epidemiology, Descriptive , Observational Study , Prospective Studies , PeruABSTRACT
We report two cases of biliary fascioliasis in patients from the highlands of Peru; with several months of symptoms characterized for biliary-type pain, dark urine and jaundice in one case. Both of them referred to the department of Gastroenterology of the Hospital Nacional Guillermo Almenara Irigoyen for suspicious of choledocolithiasis. Laboratory tests were performed which showed variable high levels of functional liver tests (cholestasis) and marked eosinophilia in one case. Magnetic resonance cholangiography (CRMN) was performed and then informed as an apparent image of biliary stone in choledocus in both cases. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and after sphincterotomy, one flattened, lanceolate parasite, with active mobility morphologically compatible with Fasciola hepatica was extracted. After the ERCP antiparasitic treatment was given with triclabendazole. Clinical outcome was favourable.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Fasciola hepatica/isolation & purification , Fascioliasis/surgery , Animals , Female , Humans , Male , Middle AgedABSTRACT
Presentamos dos casos de fascioliasis crónica en pacientes procedentes de la zona andina del Perú, con sintomatología de varios meses de evolución, con dolor tipo biliar, coluria e ictericia en uno de los casos. Ambos referidos al Servicio de Gastroenterología del Hospital Nacional Guillermo Almenara Irigoyen para estudio por sospecha de colédocolitiasis. Se les realizó exámenes de laboratorio que mostraban aumentos variables en las pruebas de función hepática (colestasis) y en uno de ellos eosinofilia marcada. Se realizó colangioresonancia magnética (CRMN) en ambos casos demostraron imagen sugestiva de cálculo en colédoco. La pancreatocolangiografía retrograda endoscópica (CPRE) fue realizada y luego de esfinterotomía, se extrajo un parásito aplanado, lanceolado, con movilidad activa morfológicamente compatible con Fasciola hepática en ambos casos. Posterior a la CPRE se inició tratamiento antiparasitario con triclabendazol, siendo la evolución clínica favorable.
We report two cases of biliary fascioliasis in patients from the highlands of Peru; with several months of symptoms characterized for biliary-type pain, dark urine and jaundice in one case. Both of them referred to the department of Gastroenterology of the Hospital Nacional Guillermo Almenara Irigoyen for suspicious of choledocolithiasis. Laboratory tests were performed which showed variable high levels of functional liver tests (cholestasis) and marked eosinophilia in one case. Magnetic resonance cholangiography (CRMN) was performed and then informed as an apparent image of biliary stone in choledocus in both cases. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and after sphincterotomy, one flattened, lanceolate parasite, with active mobility morphologically compatible with Fasciola hepatica was extracted. After the ERCP antiparasitic treatment was given with triclabendazole. Clinical outcome was favourable.
Subject(s)
Animals , Female , Humans , Male , Middle Aged , Cholangiopancreatography, Endoscopic Retrograde , Fasciola hepatica/isolation & purification , Fascioliasis/surgeryABSTRACT
OBJECTIVE: Evaluate the diagnostic and therapeutic utility, safeness, efficacy and complications of double balloon enteroscopy (DBE). METHODS: This prospective, descriptive study of DBE took place between July 2010 and November 2011 at Gastroenterology Service of Hospital Nacional Guillermo Almenara Irigoyen-EsSalud. 33 DBE were performed in 30 patients with a double balloon enteroscope: EN-450T5 Fujinon, under conscious sedation and with previous bowel preparation. All of them signed an informed consent. RESULTS: The mean hemoglobin was 9.16 gr. /dl. 16 patients (53%) had capsule endoscopy previous to the exam. The most frequent indication for DBE was gastrointestinal bleeding of obscure origin. The per-oral route was used in 66.7% of the cases reaching a maximum distance of 206 cm. The mean examination time was 137 minutes. The most frequent finding was vascular ectasia. The diagnostic yield was 57.6% (similar to other published series). The therapeutic usefulness is equal to 45.4%. The therapeutic procedure most used was argon beam plasma (ABP). As published by other authors the exam was well tolerated by all patients with no complications after the procedure. CONCLUSIONS: DBE is a secure, useful and efficient technique for the exploration and treatment of small bowel disease, mainly in the cases of gastrointestinal bleeding of unknown origin.
Subject(s)
Double-Balloon Enteroscopy , Gastrointestinal Hemorrhage/etiology , Intestinal Diseases/diagnosis , Intestine, Small/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Double-Balloon Enteroscopy/instrumentation , Double-Balloon Enteroscopy/methods , Female , Gastrointestinal Hemorrhage/therapy , Hemostasis, Endoscopic/methods , Humans , Intestinal Diseases/complications , Intestinal Diseases/therapy , Male , Middle Aged , Peru , Prospective Studies , Treatment Outcome , Young AdultABSTRACT
OBJETIVO: Evaluar la utilidad diagnostica y terapéutica, seguridad, eficacia y complicaciones de enteroscopia de doble balón (EDB). MATERIAL Y METODOS: Es un estudio descriptivo prospectivo. Se realizó en el Servicio de Gastroenterología del Hospital Guillermo Almenara Irigoyen Lima-Perú. El estudio comprendió de Julio 2010 a Noviembre 2011.Se practicaron 33 exámenes en 30 pacientes bajo sedación consciente y con preparación previa. Se utilizó un enteroscopio de doble balón EN-450T5 Fujinon. Los pacientes firmaron un consentimiento informado antes del examen. RESULTADOS: La hemoglobina promedio fue 9.16 gr/dl. Se realizaron capsula endoscópica previamente en 16 pacientes (53%). La indicación más frecuente fue la hemorragia digestiva de origen oscuro (70%). La vía de abordaje más utilizada fue la anterógrada (66.7%). La distancia máxima alcanzada fue de 206 cm vía oral. El tiempo promedio de duración fue de 137 min. Las Ectasias vasculares son los hallazgos más frecuentes. El rendimiento diagnostico fue 57.6%, similar a otras series. La utilidad terapéutica fue de 45.4%. El procedimiento terapéutico más usado fue la aplicación de argón plasma. Al igual que otras series, los pacientes toleraron la EDB muy bien, con la incomodidad transitoria y sin mayores complicaciones. CONCLUSIONES: La EDB se ha mostrado como una técnica segura, útil y eficaz para el diagnostico y tratamiento de las enfermedades del intestino delgado, sobre todo en la hemorragia digestiva de origen oscuro.
OBJECTIVE: Evaluate the diagnostic and therapeutic utility, safeness, efficacy and complications of double ballon enteroscopy (DBE). METHODS: This rpospective, descriptive study of DBE took place between July 2010 and November 2011 at Gastroenterology Service of Hospital Nacional Guillermo Almenara Irigoyen-EsSaLUD. 33 DBE were performed in 30 patients with a double ballon enteroscope: EN-450T5 Fujinon, under conscious sedation and with previous bowel preparation. All of them signed an informed consent. RESULTS: The mean hemoglobin was 9.16gr./dl. 16 patients (53%) had capsule endoscopy previous to the exam. The most frequent indication dor DBE was gastrointestinal bleeding of obscure origin. The per-oral route was used in 66.7% of the cases reaching a maximum distance of 206 cm. The mean examination time was 137 minutes. The most frequent finding was vascular ectasia. The diagnostic yield was 57.6% (similar to other published series). The therapeutic usefulness is equal to 45.4%. The therapeuthic procedure most used was argon beanm plasma (ABP). As a published by other authors the exam was well tolerated by all patients with no complications after the procedure. CONCLUSIONS: DBE is a secure, useful and effcient technique for the exploration and treatment of small bowel disease, mainly in the cases of gastrointestinal bleeding of unknown origin.